North Dakota Department of Human Services

Among other helpful information, this site provides all of the forms needed to request a Prior Authorization. You can find a form by name under PA Forms or by requested NDC in the NDC Drug Lookup application. Please download the proper form and fill it out COMPLETELY. Please fax the completed form to 855-207-0250. If you need further assistance, please contact us at 1-866-773-0695.For details about the information available on this website, view How to Use the North Dakota DHS Prior Authorization Website.

Most of the documents on this site are in .pdf format. In order to download, complete, and print these documents correctly, we recommend downloading and installing the latest version of Adobe Acrobat Reader.

DisclaimerAll attempts are made to have the most current information on this website. However, the information on this website is NOT a guarantee of current policy or limits. Application of current policy and limits will occur when the claim is processed.